Presentation Authors: Khawaja Bilal, Nir Tomer, Elie Kaplan-Marans, Mark Finkelstein, Michael Palese*, New York, NY
Introduction: To observe and compare the inpatient and outpatient utilization of extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) for the treatment of ureteral calculi in New York State between 2004 and 2014.
Methods: A retrospective cohort study of 249,265 patient records was conducted using the Statewide Planning and Research Cooperative Systems database of New York State. ICD-9 and CPT codes were used to isolate 89,905 EWSL cases, 33,895 PCNL and 125,465 URS cases. A unique identification code was used to track patients and the treatment-free rate was calculated by observing patients who did not require any further treatment in the 90-day post-op period.
Results: The annual frequency of ESWL cases remained steady over the observation period however a significant shift occurred from the inpatient hospital setting to the outpatient ambulatory care setting. ESWL cases performed in the hospital setting steadily decreased from 7116 in 2004 to 5918 in 2014 (p < 0.05) while procedures performed in the ambulatory care setting increased steadily from 941 in 2004 to 2,116 in 2014 (p < 0.01). Annual frequency of URS cases increased significantly from 9,601 in 2004 to 12,087 in 2014 (p < 0.05). Most of this growth was experienced by the outpatient setting where number of cases increased significantly from 6,551 in 2004 to 9,102 in 2014 (p < 0.01). Frequency of inpatient PCNL cases remained relatively stable over the observation period. An insignificant number of PCNL cases were found in the outpatient setting from the database and thus not included in the results. Average proportion of patients who did not require further treatment in the 90-day period following the initial procedure was 82.11% for ESWL cases, 89.58% for URS cases and 92.31% for PCNL cases.
Conclusions: Results show that between 2004-2014, significant growth was observed in the number of annual URS cases while the annual frequency of ESWL and PCNL cases remained relatively unchanged. Moreover, annual number of cases performed in the outpatient setting increased significantly for both ESWL as well as URS. The average 90-day treatment-free rate was highest for PCNL, followed by URS and lowest for ESWL cases, and this trend remained consistent over the observation period.
Source of Funding: Department of Urology - Mount Sinai Beth Israel Hospital